Diabetes Forecast

Why So Many Meds for Type 2?

I have been a type 2 for 15 years. I started with metformin, then glipizide, then 24-hour Levemir (insulin detemir), now Apidra (insulin glulisine) before meals. Why do doctors just keep adding more meds? I plan my day around my numbers and watch my weight. The cost of two insulins is breaking my budget. Help! Christine Weigand, Rochester, New York

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Craig Williams, PharmD, responds:

Type 2 diabetes is a progressive disease—the body may make less insulin over time. So more than one medication, along with regular exercise and a healthful eating plan, is often needed to achieve target blood glucose levels. There are now over 10 different classes of diabetes medications to control blood sugar.

What to Know

Which type 2 medications or combinations of meds are the “best”? In 2012, the American Diabetes Association (ADA) adopted new recommendations on this question. The ADA team concluded that there is little evidence that any one drug or combination is generally superior to another. Rather, the drugs differ, and the decision of which to use should be based more on individual patient characteristics.

In general, the ADA found good evidence that metformin is safe and effective, is durable (keeps working even after many years of use), and should be used first in most patients. After metformin, it identified five main classes of medications as the core of our treatment options: sulfonylureas (glipizide, etc.), insulin (all formulations), GLP-1 agonists (exenatide, etc.), thiazolidinediones (pioglitazone, etc.), and DPP-4 inhibitors (sitaglipitin, etc). Among those, insulin is the most potent and remains effective over years of use but also has the highest risk for causing low blood sugar. The choice of treatment for a person should primarily consider cost, risk of low blood sugar, likelihood of weight gain, and any unique side effects of a drug or drug class.

Find Out More

The American Diabetes Association’s website offers helpful information about medication options at diabetes.org/meds.

Possible Solutions

Do not be afraid to work with your health care provider to try different combinations of medications to see what works best for you.


While metformin is a good first medication for many people with type 2, the “best” med or combination of meds for a person is the one that is affordable, controls blood sugar, and is well tolerated.



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